Line sepsis in the ICU: prevention, diagnosis, and management

Intravascular devices (IVDs) are universally employed in the intensive care unit. Although their use is essential for the administration of medications and IV fluids, they carry a substantial risk of infection, either from the device itself or from contamination of administered infusate. IVD-related infections lead to increased patient morbidity and mortality and excess costs, but they are preventable. The highest rates of IVD-related infection occur with central venous catheters (CVCs). Immunosuppression and other underlying illnesses further increase the risk of IVD-related infection. Coagulase-negative staphylococci, Staphylococcus aureus, and Candida spp. are the most frequent infecting organisms. The incidence of IVD-related infections may be minimized by simple measures, including maximal barrier precautions during CVC placement, specialized training for personnel placing IVDs, and use of chlorhexidine for cutaneous antisepsis. Management of line sepsis should include blood cultures, treatment with appropriate antibiotics or antifungals, and, in most cases, removal and culture of the IVD.